Provider Demographics
NPI:1356650634
Name:SORENSON, JAMIE M (NP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:M
Last Name:SORENSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 D AVE
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-2576
Mailing Address - Country:US
Mailing Address - Phone:619-227-1423
Mailing Address - Fax:
Practice Address - Street 1:CENTER STAR ACT MENTAL HEALTH SYSTEMS
Practice Address - Street 2:4283 EL CAJON BLVD, SUITE 115
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-0001
Practice Address - Country:US
Practice Address - Phone:619-521-1743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20452363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health